STANLEY M. ARONSON: Religious bigotry got in the way of controlling malaria

When reflecting on the geographic distribution of malaria we think of the savannahs of sub-Saharan Africa, the riverside villages of southern Asia and the vivid images within Joseph Conrad's tales describing dissolute, gin-drinking Europeans sweating profusely in tropical saloons. But the image of temperate climate England as the site of malarial epidemics seems, somehow, too strange to accept.

Consider, however, England at the onset of the 17th century, a land beset by malaria. Queen Elizabeth I had died in 1603 and the Stuarts, with James I as their monarch, had assumed the rule of what was now called Great Britain.

In 1599, during the last of the Elizabethan years, a son named Oliver was born to Elizabeth and Robert Cromwell of Hunterdon, west of Cambridge. As an adult Cromwell displayed great military genius and was given command of the Parliamentary cavalry and, later, the so-called Model Army fighting the monarchy. The many battles on English soil resulted eventually in the downfall of the royalist reign in 1648 and, in 1649, the execution of Charles I. Cromwell was offered the crown, but after weeks of consideration, he finally declined the invitation. During the next few years, Cromwell was occupied with suppressing a sequence of minor royalist uprisings as well as undertaking a major campaign to subdue rebellious forces in Ireland. While there, he became ill with malaria. Cromwell recovered, but this initial attack accelerated his aging.

In 1658, while in southern England, Cromwell suffered a renewed attack of malaria. This time, however, the effects of the disease were profound and his physicians, in desperation, recommended that he receive an herbal substance derived from the bark of the cinchona tree. This bitter powder was first employed by Europeans in 1640 when Don Juan del Vego, physician to the Countess of Chinchon, treated her intermittent fevers with a common preparation used by the local Peruvians. This substance had been known variously as Jesuit's Powder, Peruvian Powder, the Countess's powder (pulvis Comitessae) or, today, as quinine. The medication was then controlled by a Spanish monopoly, based in Peru and Ecuador, but was readily available in England -- at a price. Cromwell's Protestant religion, with its anti-Catholic persuasions, however, required him to refuse any papist medication and thus he died of untreated malaria on Sept. 3, 1658, at age 59.

Malaria -- then called ague, aestivo-autumnal fever or harvest fever -- was a common disorder in southern Britain. Indeed, Shakespeare mentions it in eight of his plays. In 1658, during a malarial epidemic sweeping over London, quinine was administered to one of London's aldermen. He died and his death was immediately ascribed to a papal plot. One paper declared: "The Peruvian bark was an insidious poison which the Jesuits had brought to Europe for the purpose of exterminating all those who had thrown off their allegiance to Rome."

Quinine, to the contrary, was one of the first hugely successful specifics available to the practitioners of Western medicine. Along with digitalis, morphine and the salicylates, it constituted the timid beginnings of rational, verifiable therapy as the vocation of medicine grew from a dubious art to a science-based profession. The arrival of quinine to Britain was delayed by religious prejudice, since quinine had been so closely affiliated historically with the Jesuits. A poorly trained English apothecary, Robert Talbor, managed to change that.

Talbor was born in southern England in 1642 and underwent early training in the apothecary sciences at St. John's College. Although not trained specifically as a physician, he nonetheless proclaimed himself as a "feverologist" and published a widely read text titled, "Pyretologia: A Rational Account of the Cause and Cures of Agues." In it he declared: "Beware of all palliative cures, and especially of that known as Jesuits' Powder." He based himself in the salt marsh districts of Essex, a coastal region notorious for its heavy malarial infestation. (The children of the swampy region were known for their emaciated, sallow appearance.) He tested many empirics for the treatment of malaria and finally arrived at an extremely effective mixture, modestly named after himself, "Talbor's Wonderful Secret," for the suppression of malaria.

In 1678 England had a great epidemic of malaria during which King Charles II contracted the disease. Talbor was summoned, administered his secret syrup and the king was cured. In gratitude, Talbor was knighted and made Physician Royal to the Court. In France, malaria also affected the family of Louis XIV, and Talbor was dispatched to Paris, where his secret mixture again effected cures. Talbor was then made a Chevalier of France.

In truth, his secret anti-malarial concoction proved to be merely a mixture of quinine (Jesuits' Powder) and opium dissolved in white wine.

More than 350 years have intervened since quinine was introduced as an effective therapy for the intermittent fevers known as ague or malaria. The lengthy span makes it difficult, therefore, for historians to determine which 17th century fever was more intense: religious bigotry or malaria.

Stanley M. Aronson, M.D., is dean of medicine emeritus, Brown University. Reach him at smamd@cox.net. For more stories visit scrippsnews.com.

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